J03 vs J36
J03 and J36 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
The official note, declared on J03
peritonsillar abscess (J36)
J36
Peritonsillar abscess
Billable
- Chapter 10
- Diseases of the respiratory system
- Section
- J30-J39
Use when the record says
- abscess of tonsil
- peritonsillar cellulitis
- quinsy
Indexed under
- Peritonsillitis
- Quinsy (gangrenous)
- Abscess › circumtonsillar (connective tissue) (embolic) (fistulous) (infective) (metastatic) (multiple) (pernicious) (pyogenic) (septic)
- Abscess › intratonsillar (connective tissue) (embolic) (fistulous) (infective) (metastatic) (multiple) (pernicious) (pyogenic) (septic)
- Abscess › peritonsillar (connective tissue) (embolic) (fistulous) (infective) (metastatic) (multiple) (pernicious) (pyogenic) (septic)
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027